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Biomedical subjects

V C Roberts

Publications and source records attributed to V C Roberts.

At least 37 records · Page 2Linked to original sources
PubMed1989

Wound hematoma: prophylaxis with topical thrombin.

We studied 123 patients having elective exploratory laparotomy through a midline vertical incision for gynecologic disease; patients were randomized to receive wound irrigation with either saline or topical thrombin before closure of the incision. Seven patients were not evaluable. No patient received low-dose heparin therapy perioperatively. No patient in either group had a clinically significant wound hematoma or disruption. Minor wound hematomas were more common in the saline group, a finding that approached statistical significance. Blood coagulation profiles were not different in the two groups either preoperatively or postoperatively. Topical thrombin is probably not clinically useful in preventing wound hematomas in patients who do not receive perioperative treatment with low-dose heparin; however, it seems to be safe for application to open wounds.

Administration, Topical↗
PubMed1988

Evaluation of a computerised test for the assessment of peripheral vascular disease.

This paper reports a study carried out in 200 patients to assess the effectiveness of a clinical vascular laboratory in the routine assessment of peripheral vascular disease (PVD) of the lower limb. Laboratory assessments involved a computer based hierarchical testing system incorporating pedal pressure indices, maximum walking distances and principal component analysis of the common femoral artery blood velocity waveform. The study fell into two parts. In the first, the laboratory assessments of 100 patients referred six years ago were compared retrospectively with their eventual clinical outcome. In this comparison, the laboratory provided a "diagnosis" which was 79% correct. In the second, a double blind prospective study was carried out in 100 patients to compare the vascular laboratory "diagnosis" with the diagnosis and prognosis of a skilled clinician, the outcome being compared one year after the initial assessment. In this study the laboratory proved to be correct in 78% of cases, the clinician in 70%. With a slightly modified computer protocol for the non vascular diagnosis, the computer would have been correct in 85% of cases. This test provides a quantitative and objective assessment of PVD which can assist in the patient's clinical diagnosis and management.

Diabetic Angiopathies↗
PubMed1988

An epidemiological survey of Raynaud's phenomenon.

A questionnaire was sent to 1000 patients with Raynaud's phenomenon (RP) and an equal number of controls in order to accumulate one of the largest patient data banks currently available. Five-hundred and seventy-one correctly completed paired returns were processed so as to investigate the association between Raynaud's phenomenon and other factors suspected of influencing the condition. The involvement of female sex hormones in RP was indicated by the predominance of women (93%), a 6% (P less than 0.02) higher incidence of infertility and the influence of menstruation (15%), the menopause (73%) and pregnancy (53%) on symptoms. Patients with scleroderma had a 5% higher incidence of stillbirths. A familial predisposition for RP was noted dependent on age at onset of symptoms (age less than 30, 14% greater than 30, 4.9%). The Raynaud's group overall had a significantly higher percentage who had been treated for migraine (7% higher P less than 0.01), angina (3% higher P less than 0.05) and duodenal ulcer (3% higher P less than 0.001). Of the respondents who had undergone sympathectomy (n = 140, 24.5% of the total), 18.6% claimed lasting benefit and 66.4% claimed no benefit after one year. The mean age at sympathectomy was 38.6 years (S.D. +/- 13 range 14-78) with a mean age of start of symptoms of 29.2 years (S.D. +/- 14.7, range 0-70). There was no significant difference between the effects of sympathectomy on those patients with and those without associated conditions.

Adolescent↗
PubMed1988

The transient thermal clearance method for regional blood flow measurement--the influence of tissue heat conduction.

When heat is supplied to or retrieved from living tissue, the heat in or out is either conducted by means of the tissue or convected by blood. In order quantitatively to assess blood flow by thermal clearance the contributions of conduction and convection have to be separated, and various methods have been developed for this purpose. The various methods are reviewed and it is shown that the adequacy of each depends on the specific thermal clearance method used. The review concentrates on aspects of the role of thermal conduction in the non-invasive transient thermal clearance method. It is shown that by applying correct methodology, for regional blood flow of around 0.0025 ml blood per ml tissue per second the predominant contribution to the heat transfer is by convection. However, if the regional blood flow is much lower, the effect of heat conduction cannot be ignored.

Adult↗
PubMed1988

Assessment of regional blood flow and specific microvascular resistance in the foot by means of the transient thermal clearance method.

Measurements of skin blood flow have been made in a group of 34 patients presenting with symptoms of peripheral vascular disease. Of the patients, 18 were non-diabetic and the remainder diabetic. Measurements of blood flow were made using the transient thermal clearance method, and of systolic blood pressure in the dorsalis pedis artery using a CW ultrasonic Doppler blood velocimeter and an occluding cuff. There was no difference in pressure index between the two groups. Neither a linear pressure/flow relationship nor the presence of autoregulation was demonstrated. The derivation of specific vascular resistance (SVR) for the two groups shows that in the diabetic it was 7.07 +/- 2.2, while in the non-diabetic it was 11.12 +/- 3.9. The difference is significant (P less than 0.005) and suggests that measurement of SVR may be useful in the differential diagnosis of vascular disease.

Blood Pressure↗
PubMed1987

Limb perfusion in the lower limb amputee--a comparative study using a laser Doppler flowmeter and a transcutaneous oxygen electrode.

Accurate and objective assessment of amputation level in the lower limb plays an important role in patient management. Laser Doppler flowmetry (LDF) is a new and noninvasive technique for skin blood flow measurement and has been used pre-operatively in 25 patients undergoing amputation for vascular disease and in five normal controls. Baseline flux measurements were made at room temperature on the medial aspect of legs and then again after local heating of the skin for five minutes. Transcutaneous oxygen measurements were made at the same site for comparison and amputation level in patients selected on this basis. Significant differences (p less than 0.001) in TcPO2 values were found between controls (10.9 +/- 0.5 kPa), below-knee (BK) amputees (6.0 +/- 1.5 kPa) and above-knee (AK) amputees (1.5 +/- 0.6 kPa). Baseline LDF flux did not differ significantly between any group. Heated flux values did however show a significant difference (p less than 0.005) between controls (52.4 +/- 23.5) and both BK (20.6 +/- 9.2) and AK groups (8.1 +/- 7.7) and also between the amputee groups. The relative increase in flux (heated flux/baseline flux) differed significantly between the BK (3.3 +/- 1.5) and AK (1.2 +/- 0.3) groups (p less than 0.001) and between these two and the controls (11.2 +/- 5.4) (p less than 0.001). The correlation between relative increase in flux and TcPO2 was 0.7 (p less than 0.001). It is concluded that laser Doppler flowmetry used in conjunction with thermal stressing could provide a quick, simple and non-invasive method for objectively determining amputation level in the lower limb.

Amputees↗
PubMed1987

The effect of adjuvant oxygen therapy on transcutaneous pO2 and healing in the below-knee amputee.

The effects on tissue oxygenation of postoperative adjuvant oxygen have been studied in a group of 20 patients undergoing below-knee (BK) amputation for vascular disease. Ten patients received no therapy, the remainder receiving 28% oxygen for 48 hours following surgery. The results showed that the transcutaneous pO2 in the amputation flaps fell significantly by some 20 mmHg (p less than 0.01) following surgery and that this fall was prevented by the use of adjuvant oxygen. The fall was not observed in the non-amputated limbs. TcpO2 took almost two weeks to reach its pre-operative levels in the amputated limbs. The effect on stump healing of adjuvant oxygen therapy was investigated in a randomized controlled trial in a series of 39 patients undergoing BK amputation. There were 22 patients in the control (untreated) group and 17 in the treated group (adjuvant oxygen for 48 hours). In the treated group 14 patients healed primarily and three amputations failed. In the untreated group 14 limbs healed primarily, one secondarily and there were 7 failures. The pre-operative transcutaneous values in the stumps which failed (26 mmHg +/- 14) was significantly lower (p less than 0.005) than in those which healed (40 mmHg +/- 9). The mean pre-operative TcpO2 in the patients in whom healing occurred in the treated group (35 mmHg +/- 10) was significantly lower (p less than 0.001) than the mean pressure observed in the untreated group (44 mmHg +/- 9).

Aged↗
PubMed1987

Evaluation of introducing the team approach to the care of the amputee: the Dulwich study.

The effects of introducing the Team Approach to the management of the lower limb amputee has been assessed in a consecutive series of 233 patients over a five year period. During the first year, baseline data was collected and during the subsequent yearly phases the effects of introducing a physiotherapist co-ordinator, visiting prosthetist and medical officer from the local Artificial Limb and Appliance Centre (ALAC), and finally trained surgeons were studied. During the final phases of the study, the effects of changing team staff were monitored. The results have shown that only when the full Team Approach is adopted are the best results achieved, but that, once this approach is established, staff changes can be made without serious reductions in effectiveness. The study has shown that the team can reduce in-patient stay by 20 days; reduce the need for post-discharge physiotherapy by 94%; increase the proportion of patients discharged with a prosthesis more than fivefold and increase the effectiveness of long term rehabilitation threefold.

Amputation, Surgical↗
PubMed1986

Peritoneal cytology and invasive carcinoma of the cervix.

One hundred thirty-nine patients with invasive carcinoma of the cervix underwent laparotomy at the University of South Florida between February 1980 and November 1983. One hundred nineteen had laparotomy prior to treatment and 20 after treatment for recurrence or some other reason. One hundred twenty patients had negative peritoneal cytology, 8 had equivocal cytology and 11 had positive cytology. Positive peritoneal cytology was more common in higher-stage disease and was statistically significantly more common in patients with positive retroperitoneal lymph nodes (P less than 0.05). The rate of peritoneal cytologic positivity in patients with squamous carcinoma was the same as that for adenocarcinoma and adenosquamous carcinoma. Positive peritoneal cytology was associated with a very poor prognosis but was associated with other poor prognostic factors in all but 1 patient. Equivocal cytology did not seem to be of any particular significance. No patient in this series had an alteration in treatment planning based on peritoneal cytology. The utility and future of peritoneal cytology in invasive carcinoma of the cervix are discussed.

Actuarial Analysis↗
PubMed1985

Urinary tract fistulas following ligation of the internal iliac artery during radical hysterectomy.

One hundred patients underwent radical hysterectomy at the University of South Florida over a 4 1/2-year period. In all patients the anterior division of the internal iliac artery was ligated on the left, and the uterine artery was ligated at its origin from the internal iliac artery on the right. One patient developed a left ureterovaginal fistula for a urinary tract fistula rate of 1%. Preservation of the distal branches of the anterior division of the internal iliac artery may help prevent urinary tract fistulas following radical hysterectomy. This study would suggest, however, that this of minimal importance.

Adult↗
PubMed1985

Reflex vascular responses in the finger to contralateral thermal stimuli during the normal menstrual cycle: a hormonal basis to Raynaud's phenomenon?

1. Raynaud's phenomenon is a condition which primarily affects women and it must be assumed that hormonal influences are responsible. 2. To further investigate this assumption the effect of cyclic sex hormone fluctuations on the digital vascular reactivity of ten normal young women was studied by the diagnostic techniques of thermal entrainment of finger blood flow and Doppler ultrasound mapping of the digital arteries. 3. In the immediate pre-ovulatory period the results obtained were comparable with those found in patients with established Raynaud's phenomenon, suggesting that oestrogen has an important modulating effect in vivo on reflex peripheral vasomotor responses to thermal stimuli. 4. 'Primary' Raynaud's phenomenon may represent an exaggerated response to oestrogen.

Adolescent↗
PubMed1984

Blood flow patterns in painful diabetic neuropathy.

Peripheral blood flow is known to be qualitatively increased in diabetic patients with neuropathy. We have measured the actual blood flow in the feet of diabetic patients with neuropathy using non-invasive mercury strain gauge plethysmography and Doppler sonogram techniques and shown that it is increased on average five times above normal at an ambient temperature of 20 degrees-22 degrees C. Moreover, reduction of this high flow by sympathetic arousal stimuli proved possible in those with severe painful neuropathy contrasting strongly with failure to reverse it in those with severe non-painful sensory neuropathy. Reduction of blood flow was associated with reduction in neuropathic pain. We studied 22 diabetic patients with severe sensory neuropathy and eight with painful neuropathy. High resting foot blood flows were demonstrated in both groups with neuropathy. The big toe flow in those with severe sensory neuropathy was 29.3 +/- 9.2 ml X min-1. 100 ml-1 (mean +/- SD) and in the painful neuropathy group, 25.9 +/- 7.5, compared with 5.2 +/- 2.4 ml X min-1 X 100 ml-1 in the non-diabetic control subjects (p less than 0.001). High foot skin temperatures were also recorded in the groups with neuropathy, reflecting the high blood flow. The subjects with painful neuropathy retained the ability to constrict peripheral blood vessels in response to arousal stimuli, and reduce peripheral flow on average by 32% compared with the patients with sensory neuropathy who responded on average by only 10%. The demonstration of a peripheral sympathetic defect, responsible for the high blood flow and the potential reversal of such flow in painful neuropathy may be important in our further understanding of the aetiology of such pain and its treatment.

Adult↗